Netizen says ₹61 lakh cashless claim for ₹2.40 crore policy rejected, Niva Bupa denies ‘baseless allegation’

Patient’s cashless claim of ₹61 lakh denied for policy worth ₹2.40 crore? That’s what insurance advisor Avigyan Mitra has alleged against Niva Bupa Health Insurance, in a post on professional networking site LinkedIn.

The company on its part has denied the allegations as “baseless”, and stated that they have paid ₹22.72 lakh to the policyholder, who has been a customer since November 18, 2021.

Livemint has tried to reach out to the policyholder to get their voice on the matter.

The detailed post, which went viral on other platforms, including X (formerly Twiter) and Instagram, alleges that the policyholder’s ₹61 lakh cashless claim was denied despite having a ₹2.40 crore cover with Niva Bupa.

What do we know about the policyholder’s claim?

A post on LinkedIn claimed that a patient (identity not revealed for privacy) was undergoing treatment for Myeloid Leukaemia at the Sir HN Reliance Foundation Hospital in Mumbai. As per the post, the patient was admitted in July and urgently needed a bone marrow transplant.

The post further added that Niva Bupa had given a written confirmation approving a ₹25 lakh BMT package on July 3, calling it “final and inclusive”, but denied cashless approval for an increased hospitalisation cost — of ₹61.63 lakh ( ₹61,63,038) — citing that “liability cannot be established”.

‘Dignity, compassion, and fairness must come first’

Sharing the family’s story, the patient claimed that despite paying “premiums for years” to build the ₹2.40 crore health insurance cover — comprising of base cover of ₹1 crore and ₹1.40 crore no claim bonus, the insurer “walked away” when needed.

“Same patient. Same treatment. Same procedure. Same policy. But now the family is being forced to arrange ₹61 lakh in cash, during a life-threatening emergency. This is not a small technical issue. This is a systemic betrayal of what health insurance is supposed to stand for. Families buy policies for protection in such crises, not to be abandoned when it matters most,” the post read.

He added, “Health insurance cannot become a game of wordplay and escape clauses. When lives are at stake, dignity, compassion, and fairness must come first.”

Niva Bupa denies ‘baseless allegations’, says amount paid

In an official statement issued, Niva Bupa said they wanted to share facts about the “baseless allegation being made against Niva Bupa on social media around cashless denial of one of our policyholders”.

“Mr. Jain has been our policyholder since 18th Nov 2021. In the current year, this is his third claim instance. In the last two instances, an amount of ₹22.72 lakh has already been paid,” the statement read.

It added that Jain was admitted on June 27 for a critical procedure, for which the company “approved ₹25 lakh pre-authorisation cashless request for an initial length of stay of 27 days after discussion with the hospital”. Then additional charge of ₹77,000 was made on July 9, which was also approved.

Niva Bupa says claim not denied, questions raised over treatment cost increase

According to the company, the hospital requested an increase in pre-authorisation from initially approved ₹25 lakh to ₹61 lakh “basis an interim bill and stated that the treatment cost is escalating” and added that as of September 1, this amount has increased to ₹80 lakh.

“Since this additional amount is significantly higher than the original estimate, the subsequent pre-authorisation request for additional amount was not approved and in addition we have raised few questions with the hospital,” it said.

The company added that the customers claim has not been denied and the initially approved ₹25 lakh pre-authorisation still stands, added that the final claim amount “can only be decided at the time of discharge when the hospital shares the final discharge summary”.

It added that Niva is in regular touch with the patient’s family and have requested the hospital “not to seek any additional payments till the time justification is provided on questions raised on additional costs”.